Seniors

Overview

This overview provides a synopsis of the current knowledge base. Having considered all the information, we make sense of it by taking a stab at the following: 1) What are the priority issues that deserve attention, 2) What are opportunity areas that community or voluntary organisations can already take action on, and 3) What knowledge gaps deserve further investigation?

Priority Issues

• Mental Health
• Social Isolation

Actionable Opportunity Areas

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Knowledge Gaps

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Definitions

Definition of Seniors

• Identify and define your target group or social issue, and state who is included or excluded to provide a sense of the scope of the issue. (For example, will the page on Animal Welfare include livestock? Or just focused on pets, community animals and wildlife?)
• It is usually easier to start with national guidelines, laws or reports from apex organisations.
• Include a comparison with how other countries define the issue if possible (e.g. Local definition of Disability does not include mental health conditions)

Definitions and Models of Aging

• Chronological aging is the common view of aging, and is based on the number of years lived from birth. However, it is problematic as someone who is 40 years old today lives differently from someone who is the same age many years ago.
• An individual can experience other forms of aging. Physiological aging refers to the physical changes that reduce the efficiency of organ systems. Psychological aging refers to mental changes in sensory and perceptual process, cognitive abilities, adaptive capacity and personality.
• Within the society, an individual has several roles. Over time, an individual may experience social aging, where there are changes to his/her roles and relationships with others and in organisations.

What counts as successful ageing?

Current models of aging are aimed at facilitating successful aging, with success being defined in various ways. There are different goals of ageing which are promoted, such as healthy ageing (Kalache & Kickbusch, 1997), active ageing (World Health Organization [WHO], 2002), successful ageing (Rowe & Kahn, 1987), and productive ageing (Butler, 1983).

• Healthy Ageing: Healthy ageing adopts a biomedical view and serves as the baseline for what one should achieve in later life. It is defined as “the process of developing and maintaining the functional ability that enables wellbeing in older age” (WHO, 2020). According to this model, older adults should monitor their health to achieve health maintenance.
• Active Ageing: Later on, WHO developed the model of active ageing to further the healthy ageing agenda. WHO defines active ageing as “the process of optimizing opportunities for physical, social, and mental well-being throughout the life course to extend healthy life expectancy” (Kalache, 1999, p. 299). This model expands beyond the maintenance of bodily health functions to incorporate social participation as an important component of later life (Kalache & Kickbusch, 1997).
• Successful Ageing: The most comprehensive model is “successful ageing”, which goes beyond health and social activity emphasised by healthy ageing and active ageing respectively and incorporates productive activity. According to this model, older adults should first have a low risk of diseases and disease-related disabilities, then maintain a high level of mental and physical functions, and finally, remain engaged in social and productive activities (Rowe & Kahn, 1987). The model has received many critiques (Masoro, 2001; Stowe & Cooney, 2015), which can be grouped into four categories: 1) “missing voices” which call for more subjective components; 2) “add and stir” which call for expansions to the model; 3) “hard hitting” which demand more inclusive definitions and less stigmatisation; 4) “new frames and names” to correct or replace Western cultural bias (Martinson & Berridge, 2015). Rowe & Kahn (2015) responded with a revised model of “successful ageing 2.0”, which focuses on the societal level and recognises the importance of environmental factors in shaping later lives. The revised model suggests three main goals: 1) reengineer core societal institutions for an ageing society; 2) adopt a life course perspective to adjust the old roles at life stages; 3) focus on human capital to capitalise on the longevity dividend (Rowe & Kahn, 2015).
• Productive Ageing: In recent years, the model of productive ageing has been gaining traction in the field. The term “productive ageing” was originally coined to highlight the contributions of older adults in the United States and counter ageist perspectives. Unlike the other models which are ego-centric, the productive ageing model is relational. It emphasises the integration and engagement of older adults in activities that contribute towards their health, family, community and society (Butler, 2002; Morrow-Howell & Wang, 2013). Productivity can occur in both paid and unpaid work (https://www.csc.gov.sg/articles/reimagining-productive-longevity#notes), and according to empirical studies, productive activities are “those that produce goods and services”, such as working, caregiving, and volunteering (Butler & Gleason, 1986; Morrow-Howell et al., 2001)

Key Statistics & Figures

• 305,586 Singaporeans aged 65 and above in 2007. In 2017, 516,692 older Singaporeans. This fast pace of ageing is due to the large cohorts of post-war baby boomers getting older. The first cohort of baby boomers turned 65 in 2012.
• Advancements in healthcare and medical technologies have also increased Singapore’s life expectancy. 50 years ago, a 65-year-old person could expect to live approximately eight years more. Today, a person who is 65 can expect to live another 21 years on average.
• By 2030, the number of Singaporeans aged 65 and above is projected to double to 900,000. That means 1 in 4 Singaporeans will be in that age group, up from 1 in 8 today. (https://www.population.sg/articles/older-singaporeans-to-double-by-2030)

Map of Key Needs & Issues

[This table and arrows acts as a kind of visual map that allows a sense of sequencing; of the broad preconditions necessary for longer term outcomes to be achieved. Hyperlink the categories below to the specific page or sub-header in the page for easy navigation, so that you can click on 'Employment' below for example, and get straight to that page / segment]

Click the links below to go directly to specific areas of interest:

		Health & Well-being / Active Ageing Exercise Nutrition Wellness	↘
				Family & Caregiving Grandparenting & Intergenerational exchange	↘
						Social Inclusion Ageism Mobility & Access	→	A Good Death / End of Life
				Community Participation & Integration	↗
				Housing & Living Arrangements	↗
				Financial Security [Links to separate page on financially vulnerable seniors] Financial crisis / abuse Financial capability / Employment Financial Planning & Management	↗
		Lifelong Learning	↗

Sub-pages

• Dementia (to cross-link from Mental Health too)

Areas of Needs / Desired Outcomes

Health and Well-Being

• Desired Outcome: [For feedback] Minimise avoidable health risks and provide accessible, person-centred healthcare so that seniors can lead their desired lives
• Synopsis: [To add on]
  • Gap between intent and action with respect to healthy lifestyles: recognise the importance of health but do not take action.
  • High variance in estimated prevalence of nutritional risk among the elderly in Singapore, from 30-70% (see below) but actual rates are quite low.
  • Physical well-being affects social well-being
    • Mobility issues tend to dominate as priority medical need of the elderly, and seem to predispose elderly clients to social isolation.
• Statistics: [To add on]
  • Many suffering from chronic long-term illnesses with comorbidities instead of acute ones.
  • Only a quarter of respondents say they are ready from a health perspective to live to 100 years. Confidence in one’s readiness drops with age—from 22% of those aged 25 to 34, to half that number in the 55-64 cohort.  

Existing Programmes	Gaps & Their Causes	Possible Solutions
Physical Exercise	Gap between intent and action with respect to healthy lifestyles: recognise the importance of health but do not take action.
Nutrition	High variance in estimated prevalence of nutritional risk among the elderly in Singapore, from 30-70% (see below) but actual rates are quite low. Inconsistent definitions/standards of undernutrition Personal factors for undernutrition Institutional factors for undernutrition	Need for standardized measure (Chen et al., 2001; Lim, 2010; Pirlich & Lochs, 2001)
Wellness
Health seeking behaviours	May have insufficient knowledge about the importance of health screening and appointments Cost perception especially for the lower income elderly

Exercise

Gaps & Their Causes

• When asked how often they exercise for 20 or more minutes in a week, four in ten respondents say they do so less than twice a week and three in ten do so two to three times a week. Only two in ten indicate they regularly exercise for the duration and frequency recommended by the American Heart Association and other health organisations including Singapore’s Health Promotion Board (HPB)—30 minutes a day, five or more days a week, or 150 minutes a week. (https://readyfor100.economist.com/wp-content/uploads/2019/07/20180924-ECO035-Ready-for-100-Whitepaper-Spread.pdf)

Nutrition

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Gaps & Their Causes

• Estimated prevalence of nutritional risk among the elderly in Singapore:
  • 35 to 60 percent of the community-dwelling Chinese elderly (above 55 years old) faced nutritional risk (Yap, Niti, & Ng, 2007)
  • Higher prevalence rate of approximately 70 percent of 193 free-living older adults (above 50 years old) facing nutritional risk (Tay et al., 2016)
  • A more conservative estimate that is generally accepted by the medical community: a 30 percent rate of nutritional risk across the elderly population (Lim et al., 2012)

• Actual undernutrition
  • Study of low-income, free-living elderly people (above 55 years old) on the Public Assistance (PA) scheme found a low prevalence rate of malnutrition of only 2.8 percent, even though 50.3 percent were estimated to be at risk (Koo et al., 2014)
  • A third of older adults admitted to acute care were malnourished, indicating the existence of a high-risk group within the community prior to hospital admission (Lim, 2010). Findings are limited to elderly people with preexisting medical conditions, and little information could be derived on the nutritional health of the elderly in the wider community.
  • HPB (2010) on undernutrition
• Inconsistent definitions/standards of undernutrition (Chen et al., 2001; Lim, 2010; Pirlich & Lochs, 2001)
  • Measures commonly used to help assess undernutrition include the recommended dietary allowance (RDA) or the elderly person’s calculated energy requirements. However, these measures might be unsuitable, given the elderly’s significant physiological and health differences from the general population. In general, energy requirement also tends to be a poor gauge of nutritional health. The lack of clear standards for what constitutes elderly undernutrition has led to the use of different modes of assessment across studies, creating inconsistencies in the reporting of estimates of prevalence and risk in studies
• Personal factors for undernutrition
  • Loss: physical and psychological wellbeing; deteriorating metabolic and sensory functions, oral health, mobility, financial stability
  • Loneliness: meal as a social activity
  • Chronic illnesses
  • Lack of knowledge
• Institutional factors for undernutrition
  • Inability to reach out to key (non-gov) stakeholders
  • Resistance to change: lack of enforcement (in relation to non-gov institutions’ KPIs), occupational and linguistic differences (between trainers and caregivers, community chefs)
  • Lack of resources: budget for meals, in-house dietician

Wellness: Psychosocial

• People’s Association Wellness Programme (https://www.pa.gov.sg/our-programmes/active-ageing)
• Council for Third Age
• Senior Cluster Networks
• Community Support (https://www.csc.gov.sg/articles/transforming-community-care-in-2030)

Family & Caregiving

• Click to page on Caregivers

Grand-parenting and Intergenerational Exchange

• Desired Outcome: [To insert]
• Synopsis: [To insert]
  • Broad spectrum: those who do not see it as their responsibility/do not wish to take on the responsibility, and those who want to do it
  • Even if grandparents do not see it as their responsibility to care for their grandchildren, they recognize the lack of options available to their children and many will step forward to help
  • Underlying this phenomenon is the social expectation for women to remain in the workforce
  • Motivations for grandparenting:
    • As a favour to children
    • Out of love
    • Expectation of future returns
    • Transfer values
• Statistics: [To insert]
  • Grandparenting: According to a 2005 survey, as many as 40% of children here are cared for by their grandparents from birth until they are three years old. (Singapore Children’s Society) (https://www.ricemedia.co/culture-life-grandparenting-change-future/)

Existing Programmes	Gaps & Their Causes	Possible Solutions
Category A
Grandparenting Grandparent Caregiver Relief
Category C

Category A Programmes

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Category B Programmes

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Category C Programmes

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Intergenerational Transfers

See Financially Vulnerable Seniors#Intergenerational transfers

Housing and Living Arrangements

• Desired Outcome: Accessible, age-integrated, ageing-in-place options
• Synopsis: [To insert]
• Statistics: [To insert social isolation figures]

Existing Programmes	Gaps & Their Causes	Possible Solutions
Ageing in Place Support Caregiving Foreign Domestic Worker Support? [Trying out what might be categories we can use] Housing-related Grants?	While ageing at home may be ideal for seniors, it is only feasible if at least one of the following two conditions are fulfilled: (a) the senior has caregiver support from family members and/or foreign domestic helpers (See, 2014) and; (b) the senior remains relatively healthy and mobile. The most common alternative to ageing at home is institutionalisation, a view that is said to be “simplistic and two-dimensional” (Lim, 2016). Therefore, nursing homes remain the main option for those who suffer from mild impairment, live with family members without the time or nursing expertise, or for those living alone who are unable to hire a full-time helper (Tai & Toh, 2016).
Nursing Homes Private Voluntary Sector / Social Service Agency	Manpower shortage and high turnover rates Poor resident engagement Communication barriers [For research] VWO-run nursing homes and private nursing homes, differences in levels of dignity? Staff and nurses’ perspectives vs residents’? Existing frameworks to assess quality of care focus mostly on the clinical aspect (Donabedian, 1988; Glass, 1991; Gustafson, Sainfort, Van Konigsveld, & Zimmerman, 1990).	Include psychosocial aspects such as individualised person-centred care and better nutrition Empower residents to enhance their dignity-conserving ability Care and treatment: improve communication and feedback channels between management and residents, provide more flexibility in timetable Interests, skills, and passions: modify according to individuals, enabled through communication and profiling and creation of interest groups, engaging wider community Changing the social climate to improve social dynamics Culture of care through communication and staff welfare Culture of (dis)trust through big data Need for more holistic approach to research on living arrangements, that take into consideration emotional, social, and spiritual needs, on top of medical, clinical ones Holistic Models of Care
Age-integrated (?) Housing/ Elderly catered housing Retirement Village Kampung Admiralty Yew Tee "vertical kampung" Caters to the specific needs of the elderly residents. For example: Yew Tee Integrated Development, will house Chua Chu Kang's first hawker centre, a polyclinic, a community club, a kidney dialysis centre, a community plaza and retail shops. It will have a number of shared community spaces where the community members can come together to bond through events and activities.	Only accessible to the rich: costly and caters to their lifestyles
Category C

Ageing in Place Support

• Proximity Housing Grant
• Deferred Downpayment Scheme
• Housing benefits for seniors
• Priority schemes - Multi-Generation Priority Scheme (MGPS), Married Child Priority Scheme (MCPS), Senior Priority Scheme (SPS)
• 3Gen Flats

Nursing Homes

• The manpower shortage and high turnover rates did not merely affect daily operations; these problems also had an impact on resident engagement, which involved manpower as well.
• Communication barriers
  • Nursing home staff tended to be foreigners who were unable to speak the languages that the elderly residents spoke. However, communication may become less of a problem for future generations of residents who would be better educated and familiar with English.

Age-integrated (?) Housing

• Retirement Village
  • St Bernadette Lifestyle Village
    • Own room with personalised features, an attached bathroom that is wheelchair accessible
    • Shared living room, dining area with a small kitchenette
    • 24-hour medical concierge
    • Can invite friends over
  • Kampung Admiralty
    • Integrates housing for the elderly with a wide range of social, healthcare, communal, commercial, and retail facilities
    • 100 flats for elderly, two-storey medical centre providing specialist outpatient care, an Active Aging Hub with childcare centre, dining and retail outlets, hawker centre, community spaces
    • Only rich can afford, catering to their lifestyles

Community Participation and Integration

• Desired Outcome: [Participation in social activities, volunteerism, etc ]
• Synopsis:
  • Can reduce social isolation
  • Motivations for initial and continual volunteering: egoistic motives seem to have a much stronger influence on volunteer participation than do altruistic motives
    • Self-development
    • Altruism
    • Friends' influence
    • Remaining useful in the society
    • Improvement of health status
• Statistics: 6% of the elderly in Singapore felt socially disconnected
  • Childless seniors: https://www.ricemedia.co/culture-people-elderly-orphans/
  • Social isolation more prevalent among single men; those under home care services
  • Senior volunteerism rates
    • Cash donation is highest form of giving among seniors
    • Seniors aged 50-64 are more likely to volunteer as compared to seniors aged 65+. Those aged 50-64 tend to be educated with professional experience. Those aged 65+ tend to have retired. Top 3 motivations: want to help others, believe in the cause, religion.
    • Volunteerism rate among seniors is at 19%, while the national average is 35% (NVPC)

Existing Programmes/Services	Gaps & Their Causes	Possible Solutions
Community programmes (?)	Lack of retirement planning, especially for females Lack of aspirations/hobbies, partly due to financial constraints Lack of general participation and interest	Identify block champions Leverage organically formed subgroups Challenge existing locations Reframe retirement: gendered, socioeconomic differences in existing conceptualisations. Identify needs and aspirations of target audience
Senior Volunteerism [from your 'Productive Ageing' segment]	Seniors are aware of societal needs but doubt their ability to help (NVPC, IGS 2018). Lack of time, health Never thought about volunteering	Understand senior people’s expectations of volunteer work, provide necessary training and challenging activities, listen to senior people’s dissatisfaction with volunteer work, and so on Provide senior volunteers chances to make use of skills and knowledge, to help maintain senior volunteers’ personal growth and so on. Provide a sufficient variety of activities for senior volunteers
Elderly Befriending Services	Social disconnection among seniors, which is the lack of social, emotional and physical engagement with other people, and is strongly linked to social isolation and loneliness. 6% of the elderly in Singapore felt socially disconnected.	- Regular home visits to seniors' residences/nursing home - Providing social and psycho-emotional support to seniors - Submitting visit reports regularly to Befriender Executives (BE) - Staying alert and informing BEs if an elderly person displays unusual behaviour Examples of Befriending Services in Singapore: - Lion Befrienders Website: https://www.lionsbefrienders.org.sg/ Location: Blk 130 Bukit Merah View, #01-358 (HQ) Telephone: 1800 375 8600 - TOUCH Community Services Website: https://www.touch.org.sg/ Location: Blk 162 Bukit Merah Central #05-3545 Telephone: 6377 0122 Operating Hours: Monday to Friday from 9am to 6pm
Meal Delivery Services	Seniors may be discouraged from cooking due to immobility issues or dangers associated with operating the gas stove. Mobility issues may also inhibit the act of physically going out to takeaway food. Online food ordering platforms may also not be friendly to seniors who may not be as tech savvy.	There are meal delivery services who provides meal deliveries to homebound seniors who are unable to buy and prepare their own meals and do not have a caregiver to help them to do so. Examples of meal delivery services: - JIA Food Logistics PTE LTD, 60 Kaki Bukit Place, Eunos Techpark, #02-12, Singapore- 415979, Telephone No. +65 9471 6633 - Meal on Wheels https://www.aic.sg/care-services/meals-on-wheels

Community Programmes (?)

• Sports programmes at Active Ageing Centres (AACs)
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Senior Volunteerism

• Silver Volunteer Fund
• RSVP's "Enriching Lives of Seniors" programme
• Senior Activity Centres and Residents' Committees
• Silver Generation Ambassadors
• Community Befriending Programme
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Category C Programmes

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Lifelong Learning

• Desired Outcome: For seniors to benefit from positive psychosocial outcomes such as improved well-being, increased self-confidence, life satisfaction and self-efficacy.
• Synopsis: [To insert]
  • Learning is negatively associated with age, not unique to SG
  • Learning is positively associated with educational attainment
• Statistics: [To insert]
  • Only 13 percent of older Singaporeans took a course in the last 12 months of the survey, with major barriers cited as age, lower socioeconomic status and poor health.
  • Women are 1.3 times more likely to engage in lifelong learning compared to men. (Goh, 2019)
  • Lifelong learners are also more likely to be the younger seniors aged between 60 and 69 years old, rather than those who are aged 70 years and above. The younger seniors have a stronger educational background compared to the older cohorts of seniors, hence the likelihood to partake in lifelong learning. (Goh, 2019)
  • More educated older adults have a higher likelihood of becoming lifelong learners (Goh, 2019)
  • Those reportedly in very good health are more likely to be lifelong learners. Older Singaporeans with negligible functional limitations, including those with good vision or whose daily activities are unhindered, were also found to be more likely to engage in learning. (Goh, 2019)
    

Existing Programmes	Gaps & Their Causes	Possible Solutions
PA Senior Academy	Does not accommodate physical limitations
National Silver Academy	Technological divide, digital inequality
Category C	Open to new opportunities but won't actively seek them out

PA Senior Academy

• The People’s Association (PA) launched ‘PA Senior Academy’ on February 2015
• The key mission to encourage more seniors, 50 years old and above, to pursue lifelong learning aspirations and lead an active lifestyle by providing accessible and affordable senior- friendly courses throughout Singapore.
• Popular IT-related courses (conducted in English, and Mandarin) are specially customised to prepare seniors in tackling the challenges of managing IT gadgets, thus enhancing quality of life, and be Smart-Nation ready. These courses also promote enhanced and holistic learning experience, taught by PA IT Trainers and partners.
• The “Senior Academy Certificate” course programme will provide participants the opportunity to graduate with a Senior Academy Certificate, when they complete 10 different Senior Academy courses by 30 September 2021.

National Silver Academy

• Is a network of post secondary educational institutions and community based organisations offering a wide range of educational opportunities for seniors.
• Academy that offers short courses that range from 3 hours to as long as 12 weeks.
• These courses touch on a wide range of areas including both life-skills as well as work-skills such as business, media, IT, health and wellness and the arts.
• Singaporean seniors aged 50 and above will receive a subsidy of 50% off course fee.

Category C Programmes

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Financial Security

• Click link to separate page on Financially Security

Social Inclusion

• Desired Outcome: Need to counter social and cultural myths about aging; ageist attitudes
• Synopsis: [To insert]
• Statistics: [To insert]

Existing Programmes	Gaps & Their Causes	Possible Solutions
Countering Ageism		AARP's Disrupt Aging initiative
Countering Social Isolation		Befriending Programmes and Ground-up Initiatives, for example: Hey, You Got Mail! KampungKakis
Category C

Countering Ageism

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Countering Social Isolation

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Category C Programmes

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End of Life

• Click link to separate page on End of Life

Technology

• Desired Outcome: To reduce the digital divide via technology and to set up digital tools that enable seniors to be active participants in policymaking and service delivery.
• Synopsis:
  • Technology differentiates communities via language, age group, working/non-working, available devices e.g. laptops, smart phones.
  • Lack of technological skills being a barrier to entry to participation in digital governance; not everyone, especially the older generation, is at ease with the online tools such as websites.
• Statistics: [To insert]
  • According to the Annual Survey On Infocomm Usage in Households and by Individuals for 2019 by the Infocomm Media Development Authority (IMDA)
    • 58% of residents above 60 years old were internet users compared to 89% for all residents.
    • In 2019, 98% and 76% of senior citizens aged 50 to 59 years, and 60 years and above respectively used an Internet-enabled feature phone or smartphone in the past three months.
    • In 2019, around 6 in 10 (63%) of residents were extremely and moderately confident when making online transactions.  The highest confidence was seen among the 25-34 years old (72%) while for the 60 and above, it was the lowest (42%).

Existing Programmes	About Them
SG Digital Community Hubs	To help seniors pick up common apps like SingPass and WhatsApp, and to set up e-payment tools
Mobile Access for Seniors	Provides subsidised smartphone and mobile plan to lower-income seniors who want to go digital, but cannot afford them
Seniors Go Digital	The silver and pioneer generation, may need more assistance so they don’t get left behind. Together with our team of dedicated digital ambassadors, we are here to support our seniors on their digital journeys.

Resource Directory

Geriatric Education and Research Institute - GERI

http://geri.com.sg

A geriatric Institute based in Singapore to conduct research and education on age-related health issues to promote healthy ageing.

Tan Tock Seng Hospital's Institute of Geriatrics and Active Ageing - IGA

https://www.ttsh.com.sg/IGA/

Temasek Polytechnic’s Centre for Applied Gerontology - CAG

http://www.tp.edu.sg/centres/centre-for-applied-gerontology

Silver Horizon Travel

http://silverhorizontravel.com/

cooperative formed by seniors for travel

Lien Foundation's Eldercare Portfolio

http://www.lienfoundation.org/project-listing#ec

Tsao Foundation

https://tsaofoundation.org

International Longevity Centre (Tsao Foundation)

https://tsaofoundation.org/what-we-do/research-and-collaboration/about-ilc-singapore

Research unit under Tsao Foundation

Society for Continence (Singapore)

http://www.sfcs.org.sg/medi_page/site_web_sfcs/common_page.asp